RESUMO
BACKGROUND: Immune paralysis can be defined as a hypoinflammatory state associated with the incapacity of the immune system to release proinflammatory mediators despite the clearance of pathogens by antimicrobials. Persistent immune paralysis leads to failure to eradicate primary infections with a substantial increase in the risk of multiorgan dysfunction and mortality. The state of immune paralysis is caused mainly by the diminished ability of monocytes to release proinflammatory cytokines in response to endotoxin. This phenomenon is known as endotoxin tolerance. This study aimed to assess the role of dexmedetomidine in modifying immune paralysis in septic shock patients. METHODS: Twenty-four patients with septic shock were randomized into two groups of 12 patients. A continuous intravenous infusion of dexmedetomidine started at 0.15 µg kg-1 hr-1 and adjusted by 0.15 µg kg-1 h-1 to a maximum of 0.75 µg kg-1 h-1 (10 ml h-1), while midazolam was started at 1 mg h-1 (2 mL hr-1) and adjusted by 1 mg h-1 to a maximum of 5 mg h-1 (10 mL h-1). All infusions were adjusted by increments of 2 mL/hr-1 to maintain blinding. Serum levels of CD42a+/CD14+, HLADR+/CD14+, CRP, IL-6, IL-10 and TNF-α were measured at baseline (T1), 12 h (T2), and 24 h (T3). RESULTS: Treatment with dexmedetomidine yielded no significant difference in CD42a+/CD14+, HLADR+/CD14, CD24b-MFI, HLADR-MFI, IL6 and TREM1 at all time points when compared with midazolam treatment. There was no significant difference in TLR levels between the two groups. Cardiac output in the dexmedetomidine group showed a significant decrease at 6, 12 and 24 h (P = 0.033, 0.021, and 0.005, respectively) compared with that in the midazolam group. CONCLUSION: Our results indicated that dexmedetomidine did not affect CD42a+/CD14+ and HLA-DR+/CD14+ expression in septic patients. Furthermore, cytokine production and inflammatory biomarkers did not change with dexmedetomidine infusion. Trial registration Clinical trial.gov registry (NCT03989609) on June 14, 2019, https://register. CLINICALTRIALS: gov .
RESUMO
BACKGROUND AND AIM: Despite being in remission, functional gastrointestinal disease (FGID) in Crohn's disease (CD) patients can reduce their quality of life. The Egyptian daily diet contains a high amount of FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols). As the low FODMAP diet has been proven to be effective in irritable bowel syndrome worldwide, it was reasonable to take a step further and begin to study the effect of low FODMAP in Egyptian CD patients with FGID. The outcomes were assessed in terms of improvement in symptoms and hence the quality of life, and the factors that led to this improvement were also recorded. METHODS: In total, 100 CD patients with FGID in the remission stage who were already on a low-fiber diet (± lactose-free diet) were selected to follow the low FODMAP diet. A structured interview was performed after 3 months with a number of scored-scale questionnaires comparing symptoms before and after the diet and the impact on quality of life. Evaluation of the adherence, satisfaction, palatability, and affordability of the diet was performed. Different demographic data were also evaluated in correspondence with improvements in the quality of life. RESULTS: The mean score of FGID improvement was 38.45 ± 21.56%. The quality of life was significantly improved; 90% of female patients versus 49.4% males had a better quality of life. The households (not working) as well as those with morning jobs (6 hours) reported an increase in quality of life. Although the Egyptian low FODMAP diet was expensive (in terms of gluten-free wheat), 67% were adherent to it (18.16 ± 6.85). CONCLUSION: As a first step in Egypt, the low FODMAP diet was effective in improving the quality of life of CD patients with FGID.